Policy pathways for improving prudent and responsible use of antimicrobials in livestock: an expert-informed conceptual framework

The emergence and spread of antimicrobial resistance is driven by multiple interconnected factors, including antimicrobial use and misuse across human, animal, and environmental settings. Livestock production represents an important contributor to global antimicrobial consumption, accounting for approximately two-thirds of antimicrobial use. Effective policy interventions are essential to promote prudent antimicrobial use, protect public health and sustain livestock production. However, policymakers often lack guidance on contextually appropriate strategies, particularly in rapidly developing livestock systems. We conducted a qualitative descriptive study with 12 antimicrobial resistance policy experts from all five World Organization for Animal Health regions. Semi-structured interviews explored real-world policy initiatives, barriers to implementation, and expert perspectives to inform a conceptual framework. Targeted literature searches were conducted to independently triangulate findings. Data were analysed using directed content analysis, guided by the Behaviour Change Wheel framework, organizing interventions into seven policy categories. Expert interviews identified recurring interventions across regulatory, legislative, guideline, service provision, communication, fiscal, and environmental/social planning domains. Common barriers included inadequate surveillance, outdated legislation, and lack of industry buy-in. Contextual factors such as governance stability, cultural norms, and industry structure were critical determinants of policy feasibility. Using expert insights, we developed a conceptual framework that organizes AMU policy initiatives (and potential barriers) into three practical pathways: (1) strengthening animal health systems, (2) regulating antimicrobial supply chains, and (3) promoting guidance, training, and stewardship. No single policy is sufficient to improve antimicrobial stewardship; instead, multi-pronged, context-sensitive strategies are required. Effective interventions combine regulatory, service, and educational measures, with stakeholder engagement and equity-focused implementation. This framework provides a practical, evidence-informed foundation for policymakers to design, implement, and monitor AMU policies in livestock systems worldwide, while considering local capacities and resource constraints.